Mushroom Poisoning in North America Summary of Voluntary Reporting and News Articles for 2015 and 2016 By Michael W. Beug Chair NAMA Toxicology Committee A combination of patient confidentiality laws and expanded use of the internet for mushroom poisoning information has led to a decrease in the reporting of mushroom poisoning cases. As an organization, NAMA is engaged in discussions with Poison Centers across North America and with the Centers for Disease Control in an effort to improve reporting. Our hope is that all poison centers, doctors, veterinarians, and NAMA members will encourage anyone involved in a mushroom poisoning to file a report with NAMA. I believe that in the past NAMA has received reports on about 10% of all mushroom poisoning cases but feel that current reporting has fallen well below that 10% level. Never the less, we can gather some useful information from the data we have at hand. I have divided the material into three groups – poisoning by known toxic mushrooms, adverse reactions to commonly edible species and poisoning of animals (only dogs these past two years). Incidents are placed in alphabetical order by species of mushroom. Human poisoning from known toxic species Some Agaricus species can cause mild flu-like symptoms including vomiting and diarrhea. Many Agaricus species are hard to identify even for an expert. In one case a child vomited after consuming part of an unidentified Agaricus. What may have been Agaricus hondensis caused vomiting and nausea in an adult. Consumption of Agaricus xanthoderma (= xanthodermus) led to nausea, vomiting, diarrhea and elevated liver function tests (as well as a bill for a Hospital Emergency Room visit). Amanita phalloides, Amanita bisporigera and other members of Amanita section Phalloideae claimed a number of victims (20 in 2016 alone, with at least one death and at least three liver transplants needed). Since we received no full reports, details are sketchy. These species are covered extensively in a separate article. The important things to know here are that these mushrooms are large, beautiful, delicious and deadly, with toxins that are not destroyed by cooking. If you wish to collect wild mushrooms for the table, it is important to learn to recognize Amanita species before consuming any gilled mushroom. In 2016 we had the first ever report of the effects of consuming Amanita magniverrucata. A man consumed roughly one pound (cooked) and after a three hour delay suffered chills, sweating, vomiting and diarrhea. Other Amanita cases included one where a man suffered a rash after simply handling Amanita phalloides. Another man consumed an Amanita in the pantherina group and then felt strange, became agitated, and then vomited and had diarrhea. A couple consumed Amanita alpinicola. Both became dizzy and nauseated. One became confused and vomited. A child who suffered a seizure was thought to have eaten Amanita gemmata, but no mushroom had been eaten. Amanita smithiana was involved in three cases reported by the Oregon Poison Center and two incidents reported by NAMA mushroom poisoning identifiers. The poisonings were very serious, resulting in hospitalization and kidney damage that resolved after several days. In at least four of the cases, the victims reported that they thought that they were picking Tricholoma magnivelare, “matsutake”. We have the most detail about one of the Washington cases. A midlife man collecting by Mount Rainier had picked what he thought was matsutake. About 10 hours after cooking a meal of the mushrooms, he was not feeling well. He reported to the hospital with gastro intestinal upset. A NAMA identifier recognized Amanita smithiana from the photos. Two toxins associated with Amanita smithiana are chlorocrotylglycine and allenic norleucine, though more research is needed to determine precisely the toxic components of this mushroom. The hospital was most appreciative to learn that they should treat for a kidney toxin. Photographs and the ways to tell the Amanita smithiana and Tricholoma magnivelare apart appeared in the first 2017 issue of The Mycophile. Chlorophyllum molybdites always claims numerous victims and the past two years were no exception. At least two individuals mistook Chlorophyllum molybdites for Coprinus comatus. If you ignore the over-all shape (broad and squat versus tall and slender), ignore the gill color (white becoming greenish versus pinkish becoming black) and a few other differences (moderately spaced versus crowded gills, meaty versus soft textured, etc.), you too can enjoy a few days of vomiting and diarrhea with the added bonus of chills, headache, salivation and excessive perspiration. Of course other people who consumed this mushroom consumed it because it was growing in their yard and they assumed that anything so delicious looking in their own yard (or sometimes on their golf course) must be there for them to enjoy raw. After all, they are delicious that way. For an hour or two you can be proud of yourself for making such a meaty find. Those people learned that consumed raw, these mushrooms are even more vicious than when consumed cooked. Their vomit and diarrhea was quite bloody. Some mistook Chlorophyllum molybdites (gills white but eventually greenish from spores that are initially white but turn green when fully mature) for the highly similar Chlorophyllum rachodes (gills white and remaining white since the mature spores remain white). Unless I spore-printed every specimen, I would not eat any of the edible Chlorophyllum species except in climates where C. molybdites does not grow (e.g. the Pacific Northwest). Boletus huronensis was consumed by one person who suffered vomiting and nausea. We do not know why the mistake was made in this case but do know that Boletus huronensis, an eastern species, is sometimes mistaken for the “king bolete”. Caloboletus marshii, “the bitter bolete” was consumed by one California woman who had gone to a mushroom field day and returned to her ranch to pick a wide range of mushrooms she found growing there. She had identified the “bitter bolete” as a “butter bolete” and suffered chills, flushing and nausea. I made a similar mistake myself this summer when I collected a sack of blue-staining Caloboletus marshii fungi from my oak grove. I sampled a tiny bit raw (and spit it out). I found them to be very sweet and tasty, not at all bitter. I concluded that I might have found a new “butter bolete” species, one that did not have a netted stipe apex. I proceeded to write up a description as well as to cook a small sample batch. I only cook and sample unknown mushrooms from groups where the known similar species are edible or thought to be relatively harmless. After all, the only way to tell whether an unnamed species is edible is to eat some. If a little bit is OK, then try more a day or two later. If still OK, serve them to a few daring individuals. While I would never do this with an unknown mushroom where similar species are toxic, I have done it a few times in the past where I had good reason to anticipate a good outcome. WARNING: DO NOT DO THIS YOURSELF, MY PRACTICE IS ONLY FOR EXPERTS! In this case, after the first extremely bitter taste, I immediately identified my find as C. marshii. A few months later, under those same oak trees, I found a blue staining “butter bolete”. Since I had never before eaten a “butter bolete” or any other strongly blue-staining bolete (most are extremely bitter), I cooked up my collection. I was already positive it was Butyriboletus querciregius. That collection was delicious! Consumption of an unidentified Clitocybe species led to vomiting. Many Clitocybe species have considerable quantities of the toxin muscarine and many are difficult to identify. Clearly individuals were regularly seeking to get high on hallucinogenic mushrooms, though we rarely hear about it, even when things go badly. When we do get a report, the reason why the mushroom was consumed is rarely in the report. I only uncover it when I contact the individual(s). One couple reported explosive and burning diarrhea after consuming a Gymnopilus species. From photos, it appeared to be in the G. sapineus group. When I asked why they would even eat such a very bitter mushroom, they admitted that they had hoped to get high. Indeed, several Gymnopilus species are hallucinogenic, notably Gymnopilus spectabilis, “big laughing gym”. However, one poor soul from the Pacific Northwest discovered that mistaking that for what appeared to me from pictures to be a Pholiota, led to days of vomiting. Had he paid more attention, he would have noted that “big laughing gym” should indeed be big and should bruise blue. His mushroom had not stained blue and was not very big. To add insult to injury, our PNW look-alike to Gymnopilus spectabilis, Gymnopilus ventricosus, is not even hallucinogenic! In another PNW case, a man suffered gastro-intestinal distress after consuming a non-staining Cortinarius species thinking it was “big laughing gym”. Consumption of what was identified as Cortinarius vanduzerensis by yet another individual also resulted in an inquiry, but we do not know what the effects were or why the individual consumed this particular slimy Cortinarius. Lactarius c.f. luculentus produced vomiting in one individual. Consumption of a Lepiota similar to Lepiota cristata produced a case of gastrointestinal upset. I am particularly concerned about consumption of smallish Lepiota species because some contain amatoxins and are thus deadly poisonous. Consumption of cooked Leucopaxillus gentianeus produced a case of stomach cramps and paranoia. There were four incidents of poisoning by Jack-O-Lantern fungi (Omphalotus species) including one incident involving Omphalotus olearius and three incidents (six individuals) involving Omphalotus illudens.